Elevated biomarkers but clean lab reports? Here's why

Experts have found out that 'pre-disease' phase of having normal reports with elevated biomarkers is becoming predominantly common among young people.

Biomarkers are objective indicators of a biological process. They can be measured to show changes happening in the body. 

It could be a protein, a metabolite, chemicals or even bodily structures studied to assess the risk of diseases or their progression in the body.

Test or diagnostic readings are closely related to biomarkers but they are not the same thing.

While biomarkers are present inside the body and carry a clinical meaning, a test reading is a specific numeric value of a parameter obtained from a laboratory. It is purely a mathematical number which has to be put into the context by trained professionals.

According to a news report, unlike a biomarker, test readings themselves don’t have a larger context. They only answer the quantity of something at a particular time.

It is possible a person might have normal test readings but elevated biomarkers for a condition. It becomes important to know what it means.

Biomarkers

Biomarkers can be understood as biological substances when quantified or studied can reveal subtle changes happening inside the body.

Sometimes, these changes are minuscule enough to not be detectable by blood tests or scans.

For instance, leakage of troponin (protein found in heart muscles) could suggest heart injury, even when cardiac scans come out to be normal.

According to another media report, biomarkers serve multiple purposes: diagnosing a disease, predicting long term risk, assessing the severity of an illness and also helps in deciding a suitable treatment.

As per experts, they are an early warning system inside the body.

Speaking to DH, Dr Diksha Goyal, a consultant in internal medicine at the Marengo Asia Hospitals (Gurugram) said: “Biomarkers are like a mirror to biological processes happening inside a person’s body, they could also reflect the progression of a disease and how well it might be responding to one particular line of therapy. These measurements, if specific, are of much significance in conditions like cancer. These health conditions don’t show up suddenly on one random day, they are quietly building inside the body and often take time to show up in regular tests.”

Elevated biomarkers, normal reports

It is reasonable for a person to be confused about elevated biomarkers when the blood reports or imaging comes out clean.

As per experts, biomarkers are substances in the blood that can help predict how the body is functioning at a particular time.

It is similar to a risk assessment report prepared at one specific time, considering all the relevant factors playing out at the moment.

For instance, an elevated biomarker for liver disease can be relevant for a time window when a person is regularly consuming alcohol. 

However, the risk prediction may change with improved habits.

These markers could suggest long term risks or could spike up amidst temporary conditions like high stress, recovery from an infection, dehydration or other conditions.

During or after infections, it is reasonable for levels of C-reactive protein to shoot up in the bloodstream.

As per experts, elevated biomarkers can be a call for timely management of lifestyle errors that can develop into bigger symptoms if neglected.

Speaking to DH, Dr Nimitt Nagda, a consulting physician at the Zynova Shalby Hospital (Mumbai) said: “Factors such as smoking, alcohol consumption, or unhealthy eating patterns can cause fluctuation in marker levels. Even early-stage conditions may not show visible changes in the imaging tests, but blood markers can reflect the subtle changes building up inside the body, much before they show up as abnormalities in the standard tests."

What to do if biomarkers are elevated?

Sometimes, biomarkers can be misleading and can lead to over-diagnoses, especially if they are not specific or sensitive to a condition.

For instance, there are some tumor markers that get elevated for both cancerous and non-cancerous cells, producing false positives and pushing people to rush for advanced imaging.

Sometimes, lifestyle factors alone can skew the results.

“One abnormal report should not cause panic or anxiety. It is important to look at the overall clinical picture, including patient history, symptoms, and repeat tests if needed, and then only confirm any diagnosis. Doctors can monitor the levels over time rather than rushing into advanced tests and causing stress for the patient. Further, follow-up tests can help determine whether the elevation is temporary or requires further investigation,” said Dr Nagda.

Some experts see elevated markers as a call for more active vigilance of the risk factors.

If the biomarker is elevated, the attending professional must start with robust monitoring, providing evidence-based treatments if needed and then re-checking if the levels are back to baseline, said Dr Goyal.

More common among the young

The 'pre-disease' phase of having normal reports with elevated biomarkers is becoming predominantly common among young people, experts have found out.

Speaking to DH, Dr Sunil Rana from Asian Hospital (Faridabad) said: "It is becoming increasingly common for young people to have inflammatory markers on the edge. Standard diagnostic reports may not show disease but the body is already sending out early signs."

C-reactive protein (CRP), blood glucose levels and liver enzymes are measurable parameters that can be used to assess risk of disease. When these markers are elevated, they may indicate that the body is experiencing some type of stress, an inflammatory process, or an imbalance related to metabolic function, even if tests such as imaging studies or organ function tests remain normal, he added.

The expert showed concern around the dilemma on how to define these mixed indicators.

"If a patient were to exhibit an elevated biomarker and they already have been diagnosed with a chronic condition, it could result in anxiety from overreacting to that data. On the flip side, underreacting to elevated biomarkers could lead to more advanced and serious diseases," said Dr Rana.

Individuals who have elevated biomarkers on multiple occasions, even if those biomarkers are still considered within the range of "acceptable" values, may be showing a decline in their health and heading toward a chronic illness, said the expert.

Most experts agree on biomarkers not essentially a diagnostic tool for disease but they provide important information that should be considered when making healthcare-related decisions.